2015 Poster Presentations
10th Annual Summit Poster Presentations
Acute Stroke Treatment
Delay in Consent Is A Common Reason for Delay in tPA Administration
Sheree Murphy MS – American Heart Association/American Stroke Association; Anna Colello, JD – New York State Department of Health
Steven R. Levine, MD – SUNY Downstate Medical Center
Hospitals target the “golden hour”, tPA within 60 minutes of stroke patient arrival to speed delivery of the drug. However this target is missed in > 50% of cases and reasons for delays may be addressable. The objective of this study is to determine the type and frequency of delays in tPA treatment within New York State (NYS) and specifically contribution of consent related delays.
TeleStroke Network in Maine: A Statewide System of Care and Collaboration for Acute Stroke Patients
Tho H. Ngo, MPH; Jane G. Morris, MD; Corey Fravert, MHPM – Maine Medical Center
A Telestroke Network was implemented in Maine from a joint effort between MaineHealth, Maine Medical Center (MMC), Maine Medical Partners (MMP) Neurology, and Pen Bay Neurology to meet the demanding neurological services needs of the underserved regions in Maine. The telestroke program leverages existing board-certified neurologist specialty resources to help build a statewide community of providers and system of care to support stroke patients and their providers through the use of telehealth technology, evidence-based developed protocols, training and administrative support. The implementation of the telestroke system has increased the rates of tPA use in patients who have had a stroke in community hospitals significantly from 2014 to 2015.
General Anesthesia During Endovascular Stroke Therapy Does Not Negatively Impact Outcome
Michael F. Stiefel, MD PhD; Suneesh Anand, MD; Dipak Chandy, MD; Noorie Pednekar, MD; John V. Wainwright, MD; Arthur Wang, MD; Ramandeep Sahni, MD; Stephen Marks, MD – Westchester Medical Center
Review a single center experience and outcomes with the use of general anesthesia for patients undergoing endovascular stroke therapy with modern endovascular techniques.
Changing the Inpatient “Brain Attack” to “Code Stroke” More than a New Name
Kimberly D. Hollender, MSN, APN, CCRN, ACNP-BC; Devon Lump, MSN, ACNP-BC; Ray Bennett, BSN RN, SCRN, CEN, CFRN, CTRN, NREMT-P; Deborah Lord, RN – Robert Wood Johnson University Hospital
While aligning with state recommendations to use the universal term, “Code Stroke,” our facility concurrently reformatted the acute stroke alert activation pathway in an effort to decrease false activations. Following the implementation of this new pathway, results were compared to data from the previous year.
Measuring Impact of Pharmacist Intervention in Acute Stroke Management by Preparing rtPA in the Emergency Department
Jennifer Sposito, RN-BSN, Sanjay Mittal, MD, Kathleen Coyne, RN-BSN, Allison Dias, PharmD – UConn Health John Dempsey Hospital
In 2014, UConn Health developed a Stroke program and became a primary stroke center, following the Target Stroke Best Practice Strategies and the American Stroke Associations Acute Ischemic Stroke best care guideline of Door to Needle in less than 60 minutes. Early on it was evident that the role of our Pharmacy Department was vital to the success of timely rtPA administration. A pharmacist was added to our formal stroke alert notification and a “stroke kit” was developed containing the essentials for the rtPA administration. When the stroke alert is called the pharmacist arrives in the Emergency Department (ED) and prepares the rtPA. This process was a collaborative approach involving multiple disciplines, hospital wide education and interactive training resulting in in a reduced door to needle time and increase zero decision to needle time.
Community Education
Community Stroke Education Practices among New York State Designated Stroke Centers: The Need for State Guidelines
Ellyn Leighton-Herrmann, PhD; Mindy Hecht, MPH – Columbia University Medical Center; Anna Colello, Esq – New York State Department of Health; Crismely Perdomo, MSN, RN-BC; Olajide Williams, MD, MS – NewYork-Presbyterian/Columbia University Medical Center; Ji Chong, MD – New York Presbyterian Lower Manhattan Hospital; Daniel Labovitz, MD, MS – Montefiore Medical Center; Bill Thompsen – American Heart Association; Tiana Wyrick, RN – New York State Department of Health
Current stroke guidelines recommends treating acute ischemic stroke within 4 ½ hours of symptom onset with intravenous tissue plasminogen activator (TPA). However, the majority of patients fail to meet eligibility due to delayed hospital arrival that is often related to poor symptom recognition, lack of perceived urgency, and failure to call 911. Public stroke education is a requirement for all designated stroke centers in New York State although specific practice guidelines do not currently exist. The goal of this study was to investigate current community stroke education practices by NYS stroke centers and identify barriers to best practice. Community stroke education practices by NYS hospitals would benefit from official state guidelines that include best practices and a centralized repository of free, evidence-based outreach support tools.
Continuous Quality Improvement (CQI) Initiatives
Effect of a Rapid Protocol-Based TIA Management Pathway
Scott B. Silverman, MD; Yuchiao Chang, PhD; Ben White, MD; Melissa L. Howell, BA, BS; David F. Brown, MD; Joshua N. Goldstein, MD, PhD; Aneesh Singhal, MD; Lee H. Schwamm, MD – Massachusetts General Hospital; Susann J. Jarhult, MD, PhD – Massachusetts General Hospital and Uppsala University Hospital, Uppsala, Sweden; Mary Amatangelo, NP – Brigham and Women’s Hospital
At our institution, we developed a protocol for the diagnostic workup and management of patients with possible TIA. Our primary goal was to evaluate whether we could provide consistent, streamlined, safe and effective care while avoiding inpatient hospitalization and reducing LOS. Patients were risk stratified by ABCD2 score and neurovascular imaging; with low – moderate risk TIAs admitted to the ED observation unit, and spared inpatient admission. We found that patients admitted to the ED observation unit increased from 33% to 69% (p=0.0000). There was a significant decrease in inpatient admissions from 70% to 38% (p=0.0000) and total hospital LOS (including time in ED, observation, and inpatient) decreased from 42.6 hours to 25.8 hours (p=0.0001).
Making Sense of Inpatient Hospital Mortality Rates: The Added Value of a Detailed Clinical Case Review
Timothy G. Lukovits, MD, Diana Rojas-Soto, MD – Dartmouth-Hitchcock Medical Center; Patrick M. Chen – Geisel School of Medicine at Dartmouth
This project evaluated the characteristics of a cohort of deaths due to stroke at Dartmouth Hitchcock Medical Center (DHMC). We attempted to determine if there was a better way to identify missed non-adjustable factors in healthcare that may account for mortality and identify missed opportunities to prevent death on a regional level. The additional information gained from a detailed chart review is highlighted. We also explored how care provided prior to and during transfer and care provided at the end-of-life aimed at facilitating death might be included in the mortality review process. Several cases of possibly preventable death are described.
Developing Hospital-Specific Risk Adjusted Rates of Stroke Mortality to Support Quality Initiatives in New York
Tatiana Ledneva, MS; Anna Colello, Esq; Ian Brissette, PhD; Mary Beth Conroy, MPH; Foster Gesten, MD; Patrick Roohan, MS – New York State Department of Health
This work describes development of the hospital-specific risk adjusted rates of 30-day/in-hospital stroke mortality to support quality initiatives in New York State. The risk adjustment model was developed using Statewide Planning and Research Cooperative System (SPARCS) inpatient discharge data enhanced with 3M All Patient Refined Diagnosis Related Groups (APR-DRGs) with risk of mortality (ROM) and death information from Vital Statistics records. By incorporating deaths outside the hospital within 30 days of admission into the model, the risk-adjusted rates improve upon existing inpatient indicators used in national quality assurance and public reporting initiatives for stroke.
Rapid E-Mail Feedback After Thrombolysis at an Academic Center in New York City
Sara K. Rostanski, MD; Crismely Perdomo, MSN, RN-BC; Vepuka Kauari, MSN, RN, CEN; Olajide Williams, MD; Joshua Stillman, MD – Columbia University Medical Center/New York-Presbyterian Hospital
We initiated a novel feedback program after each thrombolysis case treated in the emergency department. Cases are tracked prospectively and each case is reviewed within 48 hours of treatment. We use a standardized form which is emailed to the multidisciplinary care team for each patient. Color-coding is used to highlight when time goals are met or unmet. Areas of delay are investigated in real-time to devise directed interventions.
Regional Differences in Stroke Center Designation and Get with the Guidelines (GWTG-S) Participation and Performance – Results from The NorthEast Cerebrovascular Consortium (NECC)
Toby Gropen, MD – Ochsner Medical Center; Charles R. Wira III, MD – Yale School of Medicine; Shannon Melluzzo, Zainab Magdon-Ismail, EdM MPH, David Day – American Heart Association/American Stroke Association; Tracy Madsen, MD, ScMCTR – Warren Alpert Medical School of Brown University; Lee H. Schwamm, MD – Massachusetts General Hospital and Harvard Medical School; on behalf of The NECC
The NECC examined differences in Primary Stroke Center (PSC) designation, participation in GWTG-S and performance of acute care hospitals (ACH) and critical access centers (CAC) in the NECC region compared to non-NECC regions. Our research shows that there has been more rapid growth of State in lieu of National PSC certification, and participation and achievement in GWTG-S in the Northeast from 2006 through 2013 compared to other regions in the U.S. The NECC may complement and enhance existing regulatory and advocacy initiatives.
Notification and Response of EMS
Results of the New York City Stroke Task Force Emergency Medical Services Stroke Prenotification Survey
Kathryn Kirchoff-Torres, MD, Daniel Labovitz, MD – Albert Einstein College of Medicine; Fabienne McClellan, MPH – University of North Carolina Health Care; Samantha Johnson, MPH – American Heart Association, Founders Affiliate; Dana Leifer, MD, FAHA – Weill Cornell Medical College, New York-Presbyterian Hospital
The American Heart Association | American Stroke Association New York City Stroke Task Force sought to assess current, regional EMS stroke prenotification experiences and identify best practices in New York City and Long Island. An online survey of 47 New York State designated stroke centers in New York City and Long Island showed that in 2014, stroke teams perceived wide variations in the rate of EMS stroke prenotifications, and receipt of prenotifications was not consistently documented. Systematic evaluation of prenotification data is essential to improve the impact of prenotifications on acute stroke treatment.
Rehabilitation
Benefits of Overground Bionic Ambulation in an Individual with Stroke: A Case Study
Erin Lampron, PT, MSPT, NCS; Erika Ozdemirer, PT, DPT, NCS; Alyse Sicklick, MD; Stephanie Zanvettor, MSPT – Gaylord Specialty Healthcare
One treatment option for persons with stroke to regain ambulatory function, and limit health risks is the use of Overground Bionic Ambulation (OBA). OBA allows users with lower extremity weakness to stand and walk. This case study report demonstrates OBA as a safe and effective gait training tool for persons with stroke.